妊娠合并血小板减少的病因分析及对分娩方式和母婴结局的影响

Etiological Analysis of Pregnancy with Thrombocytopenia and Effects on Mode of Delivery and Maternal and Infant Outcomes

摘要: 妊娠合并血小板减少(Pregnancy with Thrombocytopenia, PT)是妊娠期妇女较常见的血液系统的疾病之一，目前，国内外发病率高达70%~80%。引起该疾病的病因较复杂，是有多种内外科合并症及妊娠期并发症所导致，可涉及到血液系统，免疫系统，遗产背景等多种因素；我国以血小板计数(Blood Platelet Count, PLT)小于100 × 10^9/L，定义为血小板减少，测2次血小板其中50 < PLT < 100 × 10^9/L为轻度，30 < PLT ≤ 50 × 10^9/L为中度，血小板计数 ≤ 30 × 10^9/L者为重度。研究显示，正常妊娠中也会出现生理性血小板减少，但通常不会低于70 × 10^9/L。目前以妊娠相关性血小板减少症(Pregnancy- Associated Thrombocytopenia, PAT)、妊娠期高血压疾病(Hypertensive Disorders of Pregnancy, HDP)妊娠合并特发性血小板减少性紫癜(Idiopathic Thrombocytopenic Purpura, ITP)为病因的血小板减少多见。然而不同病因导致的血小板减少程度，分娩方式的选择及对母婴结局的影响有所不同，病理性血小板减少妇女出现产后出血、产褥感染，早产，胎儿颅内出血、新生儿窒息、新生儿血小板减少、甚至新生儿死亡的风险远大于生理性血小板减少。因此正确评估患者血小板减少的病因、选择合适的分娩方式，对于降低孕产妇及围产儿可能出现的不良结局至关重要。

Abstract: Pregnancy with thrombocytopenia (PT) is one of the common hematological diseases in pregnant women. At present, the incidence rate at home and abroad is as high as 70% ~ 80%. The etiology of the disease is complex, which is caused by various medical and surgical complications and preg-nancy complications, and can involve many factors such as blood system, immune system and her-itage background. In China, the Blood platelet count (PLT) is less than 100 × 10^9/L, which is de-fined as thrombocytopenia. After two platelet tests, 50 < PLT < 100 × 10^9/L is mild, 30 < PLT ≤ 50 × 10^9/L is moderate, and the platelet count is ≤30 × 10^9/L is severe. Studies have shown that physiological thrombocytopenia can also occur in normal pregnancy, but it is usually not lower than 70 × 10^9/L. At present, diagnosis of pregnancy-associated thrombocytopenia (PAT), Hypertensive disorders of pregnancy (HDP) and Idiopathic thrombocytopenic purpura (ITP), thrombocytopenia for the etiology is more common. However, the degree of thrombocytopenia caused by different causes, the choice of delivery mode and the impact on maternal and infant outcomes are different. The risk of postpartum hemorrhage, puerperal infection, premature delivery, fetal intracranial hemorrhage, neonatal asphyxia, neonatal thrombocytopenia and even neonatal death in pathologi-cal thrombocytopenia is far greater than that in physiological thrombocytopenia. Therefore, it is very important to correctly evaluate the etiology of thrombocytopenia and choose the appropriate delivery mode for reducing the possible adverse outcomes of pregnant women and perinatal in-fants.